Official Journal of the College of Nursing, University of Mosul

Document Type : Original Articles

Authors

1 Assist lecturer-university of Kirkuk, E mail: helanqahraman86@gmail.com

2 PhD community health nursing -university of Kirkuk,

Abstract

Background: Red blood cell transfusions are commonly used in palliative care to treat anemia or symptoms caused by anemia. In patients with advanced disease, there is little evidence of benefit to guide treatment decisions in the face of increased risk of harms. Objectives: To assess the level of knowledge and practices of nurses about blood transfusion for adult patients in Kirkuk city hospitals.
Methods: A purposive study design was conducted in the period from 1st June 2019 to 15th November 2019. the sample includes (80) nurses who were working at (Gynecology and obstetrics, General medicine, General surgery, intensive care unit, Oncology at Azadi teaching hospital, and Kirkuk general hospital.
Results: The number of nurses’ who included in the study was (35%) worked in Gynecology and obstetrics, (25%) worked in General medicine, General surgery, (10%) worked in the intensive care unit, (5%) Oncology, generally nurses had a low level of knowledge but showed best practice level.
Conclusions: The findings showed that the nurses' knowledge of blood transfusion was insufficient which could be detrimental to patient safety, also practice Was optimal in Kirkuk city hospitals
Recommendation: Nurses have the responsibility to update their knowledge and skills in carrying out blood transfusion. The tool developed in this study may be useful for educators and managers to identify gaps in knowledge and inform decisions to address them.
Keywords: Blood transfusion, Knowledge, Practice.

Keywords

BLOOD TRANSFUSION KNOWLEDGE AND PRACTICES AMONG NURSES IN KIRKUK CITY HOSPITALS

Shelan Qahraman Shakor[1], Hewa Sattar Salih[2]

 

 Abstract

Background: Red blood cell transfusions are commonly used in palliative care to treat anemia or symptoms caused by anemia. In patients with advanced disease, there is little evidence of benefit to guide treatment decisions in the face of increased risk of harms. Objectives: to assess the level of knowledge and practices of nurses about blood transfusion for adult patients in Kirkuk city hospitals.

Methods: A purposive study design was conducted in the period from 1st June 2019 to 15th November 2019.the sample include (80) nurses who were working at (Gynecology and obstetrics, General medicine, General surgery, intensive care unit, Oncology at Azadi teaching hospital and Kirkuk general hospital.

Results: The number of nurses’ who included in the study was (35%) worked in Gynecology and obstetrics, (25%) worked in General medicine, General surgery, (10%) worked in intensive care unit, (5%) Oncology, generally nurses had low level of knowledge but showed best practice level.

Conclusions: The findings showed that the nurses' knowledge of blood transfusion was insufficient which could be detrimental to patient safety, also practice Was optimal in Kirkuk city hospitals

Recommendation: Nurses have the responsibility to update their knowledge and skills in carrying out blood transfusion. The tool developed in this study may be useful for educators and managers to identify gaps in knowledge and inform decisions to address them.

Keywords: Blood transfusion, Knowledge, Practice.

INTRODUCTION

Millions of patients want blood and blood merchandise transfusions all round the world (Hijji et al,2013) . Blood infusions are outlined because the method by that the blood of 1 person is injected into another one’s circulation for medical functions. Within the early twenty century, Blood infusions contributed to varied adverse aspect effects; but, today these effects are preventable through educating medical aid suppliers and screening blood and blood merchandise. (Reza et al, 2009). Blood infusions may be a very important want for a few patients, however while not caution, it may be a grievous intervention (Aslani et al,2010). it's calculable that in each 13000 cases of Blood infusions  one error happens largely because of human errors that are preventable through applicable education and reform in insertion protocols (Bolton,2013). Concerning the vital role of nurses in a very safe and effective Blood infusions, it's necessary to enhance their information and skills (Hijji et al, 2013)  . Blood infusions may be an advanced procedure and nurses are concerned in making ready blood units, assembling blood packs, activities associated with before and once transfusion and patient safety observance. Blood infusions are a very important medical intervention which needs enough information and skills (Reza et al, 2009). Several studies are conducted on the extent of information and awareness of nurses and physicians concerning Blood infusions. However, concerning the increasing demand for insertion in hospitals and its role in saving patients’ lives, it appears necessary to enhance nurses’ level of information and performance to make sure the security of this intervention. This study aimed to gauge the impact of instructional programs on blood and blood merchandise transfusion on nurses’ level of information and skills in hospitals. (Hijji et al,2012) Blood medical aid plays a crucial therapeutic role, being employed to treat varied health issues. Innumerable efforts are created to ensure the standard of the transfusion method and therefore the security of receivers ( Pereima et al,2007)

The blood, its elements and its derivatives square measure used because the base to treat several diseases and transplants, therapy and surgery, turning them into essential and irreplaceable merchandise. Despite presenting risks by involving biological merchandise of human origin, transfusion is a vital a part of health care, promotion and recovery

 ( Ferreira et al ,2007)

In Brazil, the standardization of transfusion procedures is set by Resolution variety fifty seven of the Board of administrators (RBD), issued on Gregorian calendar month

 sixteenth 2010, that determines the Health rules (Ministério and Resolução ,2010) , and by Ordinance variety 1353, revealed by the Ministry of Health (MH) on June thirteenth,

2011. The latter determines the Technical rules for services associated with the rotary production of human blood and its elements and transfusion procedures. These rules establish rules that transfusion professionals got to apprehend and follow Ministério and Portaria ,2011 Nursing has a crucial role in making certain transfusion safety, as a result of the nursing team is answerable for knowing the indications for transfusions, checking information to stop errors, guiding patients on transfusion, police investigation and acting in compliance with transfusion reactions and documenting the procedure (timberland et al, 2009). Thanks to the complexness of the transfusion method and therefore they would like for experience throughout its development, this method needs competent and trained professionals to attain transfusion safety. Nursing professionals square measure directly concerned within the care of patients submitted to transfusion. Therefore, the proper storage of blood and its identification while not failures depends for the most part on the performance of the nursing team that highlights the importance of the knowledge base on transfusion and therefore the technical skills of the nursing workers very important Knowledge is crucial for humans, as a result of it permits attributing intending to the multiplicity of phenomena that surround them, whether or not those concerning physical objects, people, events or abstract concepts .A number of studies during this space show deficient data of the nursing workers and therefore the inappropriateness of the approaches used throughout the transfusion. There square measure few studies, however, that time out the factors which will be associated with the data deficits during this space. Based on the higher than, the target of this analysis was to see whether or not there's Associate in Nursing association between the data of the nursing team skilled regarding transfusion and therefore the variables associated with professional aspects. (Ângulo, 2007)

Objectives:

1. Assess the level of knowledge about blood transfusion for adult patients.

2. Evaluate practices of nurses about blood transfusion in Kirkuk city hospitals

 

. Table 1: number of nurses worked in settings for blood transfusion practice (𝑁 =80).

NO.

 

Areas of observation                                           

 

   Frequency    

   Percentage

            %

1-

Gynecology and obstetrics

 

25

35

2-

General medicine

 

20

25

3-

General surgery

 

20

25

4-

Intensive care unit

 

10

12.5

5-

Oncology

 

5

6.25

Table (2) Knowledge of nurses regarding blood transfusion (N= 80)

sig

MS

incorrect

correct

Items

%

F

%

F

NS

1.25

75

60

25

20

Collecting of blood from blood bank should take place before the administration of any prescribed medication

 

NS

1.28

71.2

57

28.7

23

Information to ensure collecting the right blood (Patient's identification details are on the blood bag and blood request form).

 

NS

1.3

68.7

55

31.2

25

Three aspects of information giving to patient. (Reasons for blood transfusion, risk of blood transfusion, and reaction symptoms).

 

NS

1.12

87.5

70

12.5

10

Knowledge of basic ABO terminology. (Check details with another nurse then transfuse the unit).

NS

1.18

81.2

65

18.7

15

Blood handling after delivery to ward. (Start immediately).

 

NS

1.33

66.2

53

33.7

27

Clinical indications for blood warming. (Exchange transfusion for infant, rapid transfusion, patient with cold agglutinins)

 

NS

1.2

73.7

59

26.2

21

Suitable filter size of transfusion set.

 

NS

1.3

67.5

45

32.5

26

The first action the nurse should take with mild allergic transfusion reaction. (Slow the transfusion rate and notify the doctor)

NS

1.2

72.5

58

27.5

22

Complication of rapid administration of cold blood.

 

NS

 

1.3

 

65

 

52

 

35

 

28

Indications for slow blood transfusion. (Patients with heart disease, severe anemia)

 

 

Table (3) practices of nurses before starting blood transfusion (N= 80)

   sig

MS

Not done

Done

Items

%

F

%

F

S

1.8

12.5

10

87.5

70

Explained patient about Reasons for transfusion (blood loss, low hemoglobin, and anemia)

S

1.7

21.2

17

78.7

63

Explained Risk of blood transfusion

 

S

1.5

45

36

55

 

44

 

 

Explained Benefits of blood transfusion

S

1.9

1.25

1

98

79

Documentation the explanation on Reasons for transfusion

 

S

1.6

40

32

60

48

Documentation of Patients name that matched the cross-match results and other record sheets (Blood bag number. Date. Group)

S

1.8

17.5

14

82.5

66

Documentation Risk of blood transfusion

S

1.8

11.2

9

88.7

71

Documentation Benefits of blood transfusion

 

S

 1.6

  35

  28

  65

   52

Take baseline set of vital signs (pulse, respiration, BP temperature)

   


Table (4) practices of nurses during blood transfusion (N= 80)

  sig

MS

Not done

Done

Items

%

F

%

F

 

S

1.8

50

40

   50

40

Used special tray to bring blood from laboratory   Equipments1. Cannula 18G or 19G catheter2. IV set of 0.9 % normal saline solution

    S

1.9

3.75

3

 96.2

77

Blood warmed in clean hospital linen

 

S

1.6

33.7

27

66.25

 

53

 

 

Asked patient for cross-match sheet

S

1.7

23.7

19

7 6.2

61

Perform hand hygiene Put on clean Sterile Gloves

 

S

1.9

8.75

7

91.2

73

Confirmed patency of intravenous cannula. Start IV with 18 or 19 gauge catheter if not already present keep IV open by starting flow of normal saline10

S

1.7

22.5

18

 77.5

62

Asked patient to state full name

S

1.6

37.5

30

  62.5

50

Documentation of Patients name that matched the cross-match results and other record sheets

 

S

1.9

2.5

2

97.5

78

 

Documentation Blood bag number

S

1.5

45

36

   55

44

Documentation Blood collection date

      

    S

 

1.6

 

36.2

 

  29

 

63.7

 

51

Documentation Blood group Blood component    Blood volume

 

 

S

 

1.6

 

31.2

 

25

 

  68.7

 

55

Preformed pretransfusion assessment within 30 min prior to blood transfusion and take baseline set of vital signs

S

1.9

10

8

   90

72

Recorded pretransfusion vital signs in record sheet

S

1.7

21.2

17

78.7

63

Used appropriate blood administration set

 

 Table (5) practices of nurses after starting blood transfusion (N= 80)

  sig

MS

Not done

Done

Items

%

F

%

F

 

S

1.5

43.7

35

56.2

45

Transfusion started at rate ≤ 2ml per min. start administration slowly stay with the patient for the first 5 to 15 minutes of transfusion.

S

1.6

31.2

25

68.7

55

Documented starting time

 

S

1.9

8.75

7

91.2

 

73

 

 

Stay for initial 10–15 min

S

1.7

25

20

75

60

Monitored and recorded at 15min vital sings

 

S

1.9

1.25

1

98.7

79

Advice patient/visitor to report any

unwanted symptoms: allergies, itching, flushing, fever, and back pain

S

1.8

18.75

15

81.2

65

Advise patient to report any chills, itching, rashes, or unusual symptoms

S

1.9

3.75

3

96.2

77

Use a blood warming device, if indicated especially with rapid transfusions through CVP catheter

 

S

1.8

17.5

14

82.5

   66

When transfusion is complete, clamp off blood and begin to infuse 0.9 %normal saline

    S

1.8

12.5

10

87.5

70

Remove gloves and Wash hands

    S

1.9

8.75

7

91.2

73

Record administration of blood and patient’s   reactions

 

DISCUSSION

 

Overall, nurses had important information deficits of the many facet of introduction, as proven by the terribly low mean score they achieved. These results area unit worst than reportable earlier from the United Arab Emirates (Hijji et al. 2012). Preventing and recognizing a response needs nurses to possess adequate information. The problem of assessing and guaranteeing the readiness of the patient to receive an introduction isn't at nurses. Fifty of nurses reportable that they might assess the supply and patency of intravenous access line once blood bag assortment as opposition thirty ninth during a UAE study (Hijji et al. 2012), most of the sample would administer a prescribed premedication, as opposition majority of nurses within the UAE (Hijji et al. 2012) once blood delivery to the ward. In either case, the implication is that this may eventually delay the initiation of the transfusion that may lead to microorganism contamination of the unit (McClelland, 2007). Another finding was that nurses during this study would act on an incomplete introduction order. The implication is that nurses could take fallible selections that area unit at intervals the medical domain and that they're not however prepared; this could bear uncalled-for risks to patients. Correct identification, at bedside, of a patient supposed for transfusion is vital to the interference of latest errors and detection of these that would have taken place earlier (Harris et al. 2009). Improper identification of patient is that the main explanation for incorrect transfusions (Harris et al. 2009) that ends up in patient mortality and morbidity. Nurses, therefore, hold full responsibility for patient identification as a core competence. Nurses thought of that patient identification is that the most vital action before transfusion initiation. This finding indicates that patient identification occupies the smallest amount priority; the nurses knew the right steps they need to perform to spot the patient. Failure to adjust to this easy task has been reportable in alternative studies (Hijji et al. 2012; Saillour - Glénisson et al. 2002) increasing the danger of microorganism proliferation may be a continual theme initially. This is often as a result of claimed that every unit of blood must be warm before administration victimization ancient, invalid, and risky strategies. This is often a long and wide unfold thought control by nurses and was earlier reportable from Turkey (Bayraktar & Erdil 2000) and also the UAE (Hijji et al. 2012). What nurses ought to grasp is that they need to stop this habitual apply (McClelland 2007) and understand that there are unit clinical indications for blood warming (WHO, 2002). Nurses ought to ne'er use quandary and microwave to heat blood as this might lead to lysis that may be grievous.

The nurses used ancient gravity-flow administration sets, that there's anecdotal proof of unreliable infusion time and clogged blood transfusion catheters (Houk&Whiteford,2007)                                       Uncertainty among nurses surfaced with regards to slow initiation of transfusion and frequency of significant signs recording. Nurses who worked on adult patient areas wards knew the right rate to initiate the transfusion. Each nurse ought to remember that almost all severe reactions occur throughout the primary quarter-hour of putting in a transfusion (Atterbury,2001), and therefore the severity of a reaction is proportional to the number of blood infused (Tylor et al, 2005). While not correct data, however, nurses could initiate a transfusion at a rate either slower or quicker than suggested                                                                                                                  

The outcome of this might be either prolongation of the transfusion period with an increased risk of microorganism contamination ( Mc-Clelland, 2007) or the prevalence of severe reaction (Janatpour et al, 2008). Another finding was that nurses provided the right responses regarding the frequency of recording very important signs. This finding indicates that nurses weren't responsive to the WHO (2002) recommendations; it might be a mirrored image of lack of agreement and confusion within the literature regarding this side (McClelland 2007; Atterbury 2000;; Harris et al,2009). Nurses were additionally found to own serious data deficits of the preventive practices that require being at the same time thought-about to reduce the danger for patient developing acute reaction. Admin-istering compatible blood is required; low to forestall a reaction if the period of transfusion is prolonged or if incompatible solutions area unit co-administered with blood. Acute transfusion reactions could occur in I Chronicles to twenty of patients and will be fatal (WHO, 2002). What would create a distinction to a patient's life may be a wakeful nurse WHO has the power to promptly acknowledge and with success manage hemolytic reaction. Only some numbers of nurses failed to evoke cross-match sheet before initiating transfusion, while not that the compatibility result and patients’ identification wouldn't are pointed out. This observes might be labeled because the act of negligence on a part of the nurses providing intromission, that may, at times. Similar finding has been rumored by. (Hijji et al,2010), Error associated with transfusion of incorrect blood element to the patients may well be complex . (Callum et al, 2001) and it remains one in all the biggest risks associated with transfusion. Nurses will increase compliance in unsound areas of the transfusion method and scale back the likelihood of errors by developing accessible intromission policies, auditable performance standards and coaching, and academic initiatives (grey et al,2005). Quite half the proportion wore gloves before initiating intromission, that is lesser than in different studies (Hijji et al, 2010). The patency of the intravenous tube before initiation of transfusion was checked by. Generally, most of the tending suppliers use the business intromission set out there within the market with intravenous tube. Most cases of transfusion were started at a rate cut or adequate 2ml per minute, that was in accordance with the suggested pointers. Virtually eighty percent mentioned commencement. Regarding common fraction stayed with the patient in initial quarter-hour. This can be slightly but another study wherever common fraction stayed with patients in initial fifteen minutes                   

CONCLUSION

 The findings showed that the nurses' knowledge of blood transfusion was insufficient which could be detrimental to patient safety, also practice Was optimal in Kirkuk city hospitals

RECOMMENDATIONS

1. Educational program to improve knowledge of blood transfusion  

2. The need to place guidelines and teaching program to be perform in Kirkuk city hospitals

 

REFERENCES

 

Ângulo IL. Hemoterapia moderna, práticas antigas. Rev Bras Hematol Hemoter. 2007;29(2):108–108

Atterbury, C. and Wilkinson, J. (2000). Blood transfusion. Nursing Standard, 14(34), 47-52

Aslani Y, Etemadyfar S, Noryan K. Nurses’ knowledge of blood transfusion in medical training centers of Shahrekord University of Medical Science in 2004. Iranian journal of nursing and midwifery research. 2010;15(3):141. 

Gray, C. Howell, and E. Pirie, “Improving blood transfusion: a patient-centered approach,” Nursing Standard, vol. 19, no. 26, pp. 38–42, 2005.

Bayraktar, N. and Erdil, F. (2000). Blood transfusion knowledge and practice among nurses in Turkey [Special Focus Issue: Hematology]. Journal of Intravenous Nursing, 23(5), 310-317.

Hijji, K. Parahoo, M. M. Hossain, O. Barr, and S. Murray, "Nurses’ practice of blood transfusion in the United Arab Emirates: An observational study,” Journal of Clinical Nursing, vol. 19, no. 23-24, pp. 3347–3357, 2010.

Bolton-Maggs PH. Transfusion safety in 2012: main messages from the SHOT Annual Report for 2012. Transfusion medicine (Oxford, England) 2013;23(4):217–8. 

Ferreira O, Martinez EZ, Mota CA, Silva AM. Avaliação do conhecimento sobre hemoterapia. Rev Bras Hematol Hemoter. 2007;29(2):160–167. 

Hijji, B, Parahoo, K., Hussein, M. and Barr, O. (2012). Knowledge of blood transfusion among nurses. Journal of Clinical Nursing, doi: 10.1111/j.1365-2702.2012.04078.x.

Hijji B, Parahoo K, Hussein MM, Barr O. Knowledge of blood transfusion among nurses. Journal of clinical nursing. 2013;22(17-18):2536–50. 

Hijji BM, Oweis AE, Dabbour RS. Measuring knowledge of blood transfusion: A survey of Jordanian nurses. Am Int J Contemp Res. 2012; 2:77–94. 

Houck, D. and Whiteford, J. (2007). Improving patient outcomes: Transfusion with infusion pump for peripherally inserted central catheters and other vascular access devices. Journal of Infusion Nursing. 30(6): 341-344.

Harris, A., Atterbury, C., Chaffe, B., Elliott, C., Hawkins, T., Hennem, S., Howell, C., Jones, J., Murray, S., New, H., Norfolk, D., Pirie, L., Russell, J. and Taylor, C. (2009). Guideline on the administration of blood components. British Committee for Standards in Haematology.

Janatpour, K.; Kalmin, N.; Jensen, H. and Holland, P. (2008). Clinical outcomes of ABO-incompatible RBC transfusions. American Journal of Clinical Pathology. 129:276-281.

J. L. Callum, H. S. Kaplan, L. L. Merkley et al., “Reporting of near-miss events for transfusion medicine: Improving transfusion safety,” Transfusion, vol. 41, no. 10, pp. 1204–1211, 2001.

McClelland D (2007). Handbook of Transfusion Medicine. 4th edition. London: TSO

Ministério da Saúde (BR) Resolução da Diretoria Colegiada nº 57, de 16 de dezembro de 2010. Determina o Regulamento Sanitário para serviços que desenvolvem atividades relacionadas ao ciclo produtivo do sangue humano e componentes e procedimentos transfusionais. http://portal.anvisa.gov.br/wps/ wcm/connect/fd337280474597529fcbdf3fbc4c6735/ RDC_n%C2%BA_57.pdf?MOD=AJPERES

Ministério da Saúde (BR) Portaria nº 1353, de 13 de junho de 2011. Aprova o Regulamento Técnico de Procedimentos Hemoterápicos. http://portal.anvisa.gov.br/wps/ wcm/connect/0a8db8804798da559fe7bf11eefca640/ Portaria_n_1353_2011.pdf?MOD=AJPERES

Pereima RSMR, Arruda MW, Reinnitz KS, Gelbcke FL. Projeto escola do centro de hematologia e hemoterapia de Santa Catarina uma estratégia de política pública. Texto Contexto Enferm. 2007;16(3):546–552. 

Reza PA, Aziz SV, Ali MA, Marjan MH, Reza TM. Evaluation of knowledge of healthcare workers in hospitals of Zabol city on proper methods of blood and components transfusion. Asian journal of transfusion science. 2009;3(2):78–81. 

SaillourGlenisson, F., Mathou-linPelissier, S., Galp-erine, I., Fialon, P. and Salmi, L (2002) Factors associated with nurses' poor knowledge and practice of transfusion safety in Aquitaine, France. Journal of Quality in Health Care, 14, 25-32.

 

Silva MA, Torres GV, Melo GSM, Costa IKF, Tiburcio MP, Farias TYA. Conhecimento da equipe de enfermagem no processo transfusional. Ciênc Cuidado Saúde. 2009;8(4):571–578. 

Tylor, C., Lillis, C. and LeMone, P. (2005). Funda-mental of Nursing. 5th edition. Philadelphia: JB Lippincott

World Health Organization (2002). The Clinical Use of Blood Handbook. Geneva: WHO



[1] Assist lecturer-university of Kirkuk, E mail: shelanqahraman86@gmail.com

[2] PhD community health nursing -university of Kirkuk,

 

Ângulo IL. Hemoterapia moderna, práticas antigas. Rev Bras Hematol Hemoter. 2007;29(2):108–108
Atterbury, C., and Wilkinson, J. (2000). Blood transfusion. Nursing Standard, 14(34), 47-52
Aslani Y, Etemadyfar S, Norman K. Nurses’ knowledge of blood transfusion in medical training centers of Shahrekord University of Medical Science in 2004. Iranian journal of nursing and midwifery research. 2010;15(3):141. 
Gray, C. Howell, and E. Pirie, “Improving blood transfusion: a patient-centered approach,” Nursing Standard, vol. 19, no. 26, pp. 38–42, 2005.
Bayraktar, N. and Erdil, F. (2000). Blood transfusion knowledge and practice among nurses in Turkey [Special Focus Issue: Hematology]. Journal of Intravenous Nursing, 23(5), 310-317.
Hijji, K. Parahoo, M. M. Hossain, O. Barr, and S. Murray, "Nurses’ practice of blood transfusion in the United Arab Emirates: An observational study,” Journal of Clinical Nursing, vol. 19, no. 23-24, pp. 3347–3357, 2010.
Bolton-Maggs PH. Transfusion safety in 2012: main messages from the SHOT Annual Report for 2012. Transfusion medicine (Oxford, England) 2013;23(4):217–8. 
Ferreira O, Martinez EZ, Mota CA, Silva AM. Avaliação do conhecimento sobre hemoterapia. Rev Bras Hematol Hemoter. 2007;29(2):160–167. 
Hijji, B, Parahoo, K., Hussein, M. and Barr, O. (2012). Knowledge of blood transfusion among nurses. Journal of Clinical Nursing, doi: 10.1111/j.1365-2702.2012.04078.x.
Hijji B, Parahoo K, Hussein MM, Barr O. Knowledge of blood transfusion among nurses. Journal of clinical nursing. 2013;22(17-18):2536–50. 
Hijji BM, Oweis AE, Dabbour RS. Measuring knowledge of blood transfusion: A survey of Jordanian nurses. Am Int J Contemp Res. 2012; 2:77–94. 
Houck, D. and Whiteford, J. (2007). Improving patient outcomes: Transfusion with infusion pump for peripherally inserted central catheters and other vascular access devices. Journal of Infusion Nursing. 30(6): 341-344.
Harris, A., Atterbury, C., Chaffe, B., Elliott, C., Hawkins, T., Hennem, S., Howell, C., Jones, J., Murray, S., New, H., Norfolk, D., Pirie, L., Russell, J. and Taylor, C. (2009). Guideline on the administration of blood components. British Committee for Standards in Haematology.
Janatpour, K.; Kalmin, N.; Jensen, H. and Holland, P. (2008). Clinical outcomes of ABO-incompatible RBC transfusions. American Journal of Clinical Pathology. 129:276-281.
J. L. Callum, H. S. Kaplan, L. L. Merkley et al., “Reporting of near-miss events for transfusion medicine: Improving transfusion safety,” Transfusion, vol. 41, no. 10, pp. 1204–1211, 2001.
McClelland D (2007). Handbook of Transfusion Medicine. 4th edition. London: TSO
Ministério da Saúde (BR) Resolução da Diretoria Colegiada nº 57, de 16 de dezembro de 2010. Determina o Regulamento Sanitário para serviços que desenvolvem atividades relacionadas ao ciclo produtivo do sangue humano e componentes e procedimentos transfusionais. http://portal.anvisa.gov.br/wps/ wcm/connect/fd337280474597529fcbdf3fbc4c6735/ RDC_n%C2%BA_57.pdf?MOD=AJPERES
Ministério da Saúde (BR) Portaria nº 1353, de 13 de junho de 2011. Aprova o Regulamento Técnico de Procedimentos Hemoterápicos. http://portal.anvisa.gov.br/wps/ wcm/connect/0a8db8804798da559fe7bf11eefca640/ Portaria_n_1353_2011.pdf?MOD=AJPERES
Pereima RSMR, Arruda MW, Reinnitz KS, Gelbcke FL. Projeto escola do centro de hematologia e hemoterapia de Santa Catarina uma estratégia de política pública. Texto Contexto Enferm. 2007;16(3):546–552. 
Reza PA, Aziz SV, Ali MA, Marjan MH, Reza TM. Evaluation of knowledge of healthcare workers in hospitals of Zabol city on proper methods of blood and components transfusion. Asian journal of transfusion science. 2009;3(2):78–81. 
SaillourGlenisson, F., Mathou-linPelissier, S., Galp-erine, I., Fialon, P. and Salmi, L (2002) Factors associated with nurses' poor knowledge and practice of transfusion safety in Aquitaine, France. Journal of Quality in Health Care, 14, 25-32.
Silva MA, Torres GV, Melo GSM, Costa IKF, Tiburcio MP, Farias TYA. Conhecimento da equipe de enfermagem no processo transfusional. Ciênc Cuidado Saúde. 2009;8(4):571–578. 
Tylor, C., Lillis, C., and LeMone, P. (2005). Fundamental of Nursing. 5th edition. Philadelphia: JB Lippincott
World Health Organization (2002). The Clinical Use of Blood Handbook. Geneva: WHO